|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
OP
|
$890.60
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$890.60 |
| Rate for Payer: Aetna Commercial |
$801.54
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$863.88
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$690.48
|
| Rate for Payer: BCN Commercial |
$690.48
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$712.48
|
| Rate for Payer: Cash Price |
$712.48
|
| Rate for Payer: Cofinity Commercial |
$837.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$890.60
|
| Rate for Payer: Healthscope Whirlpool |
$863.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$801.54
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$757.01
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$810.45
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$632.33
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.73
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
OP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$1,210.32 |
| Rate for Payer: Aetna Commercial |
$1,089.29
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$1,174.01
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$938.36
|
| Rate for Payer: BCN Commercial |
$938.36
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$1,137.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$1,210.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,089.29
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,101.39
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$859.33
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.08
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
IP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$847.22 |
| Max. Negotiated Rate |
$1,210.32 |
| Rate for Payer: Aetna Commercial |
$1,089.29
|
| Rate for Payer: ASR ASR |
$1,174.01
|
| Rate for Payer: BCBS Trust/PPO |
$938.36
|
| Rate for Payer: BCN Commercial |
$938.36
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$1,137.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.26
|
| Rate for Payer: Healthscope Commercial |
$1,210.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.01
|
| Rate for Payer: Mclaren Commercial |
$1,089.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.08
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
IP
|
$2,354.05
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,647.84 |
| Max. Negotiated Rate |
$2,354.05 |
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,825.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.73
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
OP
|
$2,354.05
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,354.05 |
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,825.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.73
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,142.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,428.13
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,671.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,114.25
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR BREAST W CON
|
Facility
|
IP
|
$2,354.05
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,647.84 |
| Max. Negotiated Rate |
$2,354.05 |
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,825.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.73
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
|
|
HC MR BREAST W CON
|
Facility
|
OP
|
$2,354.05
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.04 |
| Max. Negotiated Rate |
$2,354.05 |
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: BCBS Complete |
$941.62
|
| Rate for Payer: BCBS Complete |
$627.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,825.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.73
|
| Rate for Payer: BCCCP Commercial |
$358.33
|
| Rate for Payer: BCCCP Commercial |
$358.33
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.05
|
| Rate for Payer: Priority Health Narrow Network |
$252.04
|
| Rate for Payer: Priority Health Narrow Network |
$252.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
IP
|
$2,091.10
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,463.77 |
| Max. Negotiated Rate |
$2,091.10 |
| Rate for Payer: Aetna Commercial |
$1,881.99
|
| Rate for Payer: ASR ASR |
$2,028.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.23
|
| Rate for Payer: BCN Commercial |
$1,621.23
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,965.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.88
|
| Rate for Payer: Healthscope Commercial |
$2,091.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,028.37
|
| Rate for Payer: Mclaren Commercial |
$1,881.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,777.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.17
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
OP
|
$2,091.10
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$2,091.10 |
| Rate for Payer: Aetna Commercial |
$1,881.99
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$2,028.37
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.23
|
| Rate for Payer: BCCCP Commercial |
$233.67
|
| Rate for Payer: BCN Commercial |
$1,621.23
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,965.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$2,091.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,028.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,881.99
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,777.44
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.70
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$197.36
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.17
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,538.00 |
| Rate for Payer: Aetna Commercial |
$1,384.20
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,491.86
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,192.41
|
| Rate for Payer: BCCCP Commercial |
$225.34
|
| Rate for Payer: BCN Commercial |
$1,192.41
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,230.40
|
| Rate for Payer: Cash Price |
$1,230.40
|
| Rate for Payer: Cofinity Commercial |
$1,445.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,538.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,491.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,384.20
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.30
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.70
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$197.36
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,353.44
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,076.60 |
| Max. Negotiated Rate |
$1,538.00 |
| Rate for Payer: Aetna Commercial |
$1,384.20
|
| Rate for Payer: ASR ASR |
$1,491.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,192.41
|
| Rate for Payer: BCN Commercial |
$1,192.41
|
| Rate for Payer: Cash Price |
$1,230.40
|
| Rate for Payer: Cofinity Commercial |
$1,445.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.40
|
| Rate for Payer: Healthscope Commercial |
$1,538.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,491.86
|
| Rate for Payer: Mclaren Commercial |
$1,384.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,353.44
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
OP
|
$2,111.40
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$2,111.40 |
| Rate for Payer: Aetna Commercial |
$1,900.26
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$2,048.06
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.97
|
| Rate for Payer: BCN Commercial |
$1,636.97
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,689.12
|
| Rate for Payer: Cash Price |
$1,689.12
|
| Rate for Payer: Cofinity Commercial |
$1,984.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,689.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$2,111.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,900.26
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,794.69
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,921.37
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,499.09
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,858.03
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
IP
|
$2,111.40
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,477.98 |
| Max. Negotiated Rate |
$2,111.40 |
| Rate for Payer: Aetna Commercial |
$1,900.26
|
| Rate for Payer: ASR ASR |
$2,048.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.97
|
| Rate for Payer: BCN Commercial |
$1,636.97
|
| Rate for Payer: Cash Price |
$1,689.12
|
| Rate for Payer: Cofinity Commercial |
$1,984.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,689.12
|
| Rate for Payer: Healthscope Commercial |
$2,111.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,048.06
|
| Rate for Payer: Mclaren Commercial |
$1,900.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,794.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,858.03
|
|
|
HC MR CARDIAC MORP AND FUNC WO W CON
|
Facility
|
IP
|
$971.55
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$680.08 |
| Max. Negotiated Rate |
$971.55 |
| Rate for Payer: Aetna Commercial |
$874.40
|
| Rate for Payer: ASR ASR |
$942.40
|
| Rate for Payer: BCBS Trust/PPO |
$753.24
|
| Rate for Payer: BCN Commercial |
$753.24
|
| Rate for Payer: Cash Price |
$777.24
|
| Rate for Payer: Cofinity Commercial |
$913.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.24
|
| Rate for Payer: Healthscope Commercial |
$971.55
|
| Rate for Payer: Healthscope Whirlpool |
$942.40
|
| Rate for Payer: Mclaren Commercial |
$874.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$825.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$854.96
|
|
|
HC MR CARDIAC MORP AND FUNC WO W CON
|
Facility
|
OP
|
$971.55
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$971.55 |
| Rate for Payer: Aetna Commercial |
$874.40
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$942.40
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$753.24
|
| Rate for Payer: BCN Commercial |
$753.24
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$777.24
|
| Rate for Payer: Cash Price |
$777.24
|
| Rate for Payer: Cofinity Commercial |
$913.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$971.55
|
| Rate for Payer: Healthscope Whirlpool |
$942.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$874.40
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$825.82
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.11
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$689.80
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$854.96
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR CARDIAC VELOCITY MAPPING
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,093.50
|
| Rate for Payer: ASR ASR |
$1,178.55
|
| Rate for Payer: BCBS Complete |
$486.00
|
| Rate for Payer: BCBS Trust/PPO |
$941.99
|
| Rate for Payer: BCN Commercial |
$941.99
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,142.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.55
|
| Rate for Payer: Mclaren Commercial |
$1,093.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,105.65
|
| Rate for Payer: Priority Health Narrow Network |
$862.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.20
|
|
|
HC MR CARDIAC VELOCITY MAPPING
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,093.50
|
| Rate for Payer: ASR ASR |
$1,178.55
|
| Rate for Payer: BCBS Trust/PPO |
$941.99
|
| Rate for Payer: BCN Commercial |
$941.99
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,142.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.55
|
| Rate for Payer: Mclaren Commercial |
$1,093.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.20
|
|
|
HC MR CHEST W CON
|
Facility
|
OP
|
$2,287.25
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,287.25 |
| Rate for Payer: Aetna Commercial |
$2,058.52
|
| Rate for Payer: Aetna Medicare |
$711.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: ASR ASR |
$2,218.63
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.30
|
| Rate for Payer: BCN Commercial |
$1,773.30
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,829.80
|
| Rate for Payer: Cash Price |
$1,829.80
|
| Rate for Payer: Cofinity Commercial |
$2,150.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,829.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$2,287.25
|
| Rate for Payer: Healthscope Whirlpool |
$2,218.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$711.71
|
| Rate for Payer: Mclaren Commercial |
$2,058.52
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,944.16
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$782.88
|
| Rate for Payer: PHP Medicaid |
$389.31
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,698.84
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,359.07
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,012.78
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: VA VA |
$711.71
|
|
|
HC MR CHEST W CON
|
Facility
|
IP
|
$2,287.25
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,601.08 |
| Max. Negotiated Rate |
$2,287.25 |
| Rate for Payer: Aetna Commercial |
$2,058.52
|
| Rate for Payer: ASR ASR |
$2,218.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.30
|
| Rate for Payer: BCN Commercial |
$1,773.30
|
| Rate for Payer: Cash Price |
$1,829.80
|
| Rate for Payer: Cofinity Commercial |
$2,150.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,829.80
|
| Rate for Payer: Healthscope Commercial |
$2,287.25
|
| Rate for Payer: Healthscope Whirlpool |
$2,218.63
|
| Rate for Payer: Mclaren Commercial |
$2,058.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,944.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,012.78
|
|
|
HC MR CHEST WO CON
|
Facility
|
OP
|
$1,992.40
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,992.40 |
| Rate for Payer: Aetna Commercial |
$1,793.16
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,932.63
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.71
|
| Rate for Payer: BCN Commercial |
$1,544.71
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,593.92
|
| Rate for Payer: Cash Price |
$1,593.92
|
| Rate for Payer: Cofinity Commercial |
$1,872.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,992.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,793.16
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.54
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,473.59
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.87
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,753.31
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR CHEST WO CON
|
Facility
|
IP
|
$1,992.40
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,394.68 |
| Max. Negotiated Rate |
$1,992.40 |
| Rate for Payer: Aetna Commercial |
$1,793.16
|
| Rate for Payer: ASR ASR |
$1,932.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.71
|
| Rate for Payer: BCN Commercial |
$1,544.71
|
| Rate for Payer: Cash Price |
$1,593.92
|
| Rate for Payer: Cofinity Commercial |
$1,872.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.92
|
| Rate for Payer: Healthscope Commercial |
$1,992.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.63
|
| Rate for Payer: Mclaren Commercial |
$1,793.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,753.31
|
|
|
HC MR CHEST WO W CON
|
Facility
|
OP
|
$2,992.94
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,992.94 |
| Rate for Payer: Aetna Commercial |
$2,693.65
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,903.15
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.43
|
| Rate for Payer: BCN Commercial |
$2,320.43
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cofinity Commercial |
$2,813.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,992.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,903.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,693.65
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.00
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,942.04
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,553.63
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,633.79
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR CHEST WO W CON
|
Facility
|
IP
|
$2,992.94
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,095.06 |
| Max. Negotiated Rate |
$2,992.94 |
| Rate for Payer: Aetna Commercial |
$2,693.65
|
| Rate for Payer: ASR ASR |
$2,903.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.43
|
| Rate for Payer: BCN Commercial |
$2,320.43
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cofinity Commercial |
$2,813.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.35
|
| Rate for Payer: Healthscope Commercial |
$2,992.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,903.15
|
| Rate for Payer: Mclaren Commercial |
$2,693.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,633.79
|
|
|
HC MR ELASTOGRAPHY
|
Facility
|
IP
|
$352.92
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$247.04 |
| Max. Negotiated Rate |
$352.92 |
| Rate for Payer: Aetna Commercial |
$317.63
|
| Rate for Payer: ASR ASR |
$342.33
|
| Rate for Payer: BCBS Trust/PPO |
$273.62
|
| Rate for Payer: BCN Commercial |
$273.62
|
| Rate for Payer: Cash Price |
$282.34
|
| Rate for Payer: Cofinity Commercial |
$331.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.34
|
| Rate for Payer: Healthscope Commercial |
$352.92
|
| Rate for Payer: Healthscope Whirlpool |
$342.33
|
| Rate for Payer: Mclaren Commercial |
$317.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.57
|
|
|
HC MR ELASTOGRAPHY
|
Facility
|
OP
|
$352.92
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$352.92 |
| Rate for Payer: Aetna Commercial |
$317.63
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$342.33
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$273.62
|
| Rate for Payer: BCN Commercial |
$273.62
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$282.34
|
| Rate for Payer: Cash Price |
$282.34
|
| Rate for Payer: Cofinity Commercial |
$331.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$352.92
|
| Rate for Payer: Healthscope Whirlpool |
$342.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$317.63
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.98
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.70
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$197.36
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.57
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
